Consumer-Driven Healthcare, my ear
A deeper look into the new healthcare buzzword.
with Amy Tenderich
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
September 2006 —Consumer-Driven Healthcare, Definition (according to the more optimistic experts): "a new approach to health business, economics and public policy which attempts to leverage the power of the healthcare consumer (a.k.a, the ‘patient') to address the many dysfunctions of the modern healthcare economy."
You might call "consumer-driven healthcare" the Next Big Idea in medical services marketing. But like so many buzzwords, it seems to mean everything and nothing. As a person who spends a huge chunk of my disposable income (not to mention my time and effort) on medical products and services, I can't help noticing that not much about the U.S. healthcare system feels very consumer-driven right now.
How to Treat a Customer
What does the term "consumer-driven healthcare" mean to you? My first thought was that it meant healthcare organizations, like other businesses, are realizing that customers are no longer simply "targets" for their marketing efforts – but instead must be treated as integral partners with whom they work closely to enhance the value of their products or services. Hah! Partners, my ear! A pretty vision, but a "vision" just the same.
If healthcare were consumer-driven, it wouldn't take 45 minutes to get through to a real live person on the phone line when you called your provider with a claim question.
If healthcare were consumer-driven, "maintenance" prescriptions (medications you need over long periods of time) wouldn't require complicated pre-authorization forms from your doctor, which are usually rejected the first time around.
If healthcare were consumer-driven, basic allergy medications like Zyrtec wouldn't be so hard to come by, and wouldn't cost $25 a bottle out-of-pocket.
If healthcare were consumer-driven, patients wouldn't be forced to choose between complex HMO, PPO, and POS plan options that leave a loophole for various "medical groups" to decline responsibility for specific doctor's office visits or treatments (sticking the befuddled patient with the full bill).
A Business Horizons report on customer-driven marketing explains that when it comes to customer integration, companies tend to go through three phases: 1) Bliss (ignorance), 2) Awareness (when they set up telephone hotlines and try to address "customer satisfaction"), and finally, 3) Commitment.
In the diabetes world, at least, some of the more nimble startup technology companies like DexCom (continuous glucose monitoring) and Insulet (next-generation insulin pumps) are already at the Commitment Phase, working directly with customers for input as they develop their products and services. But let's face it: most of the big pharmaceutical companies, insurance providers, and larger healthcare organizations are now in Phase 2 at best. They've got a ways to go to reach "customer-driven healthcare"!
The Patient Pays
As it turns out, the consumer-driven healthcare "movement" is mostly about "allowing patients to directly control some of their health care dollars" through special tax-sheltered Healthcare Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs).
The idea is to create a competitive health insurance market, where consumers can choose among a number of different plans that best meet their health needs. Currently, we consumers are stuck with the plans available in our home state only. So this smorgasbord of health plan choices sounds quite appealing, especially since lobbyists are pushing for a policy called "guaranteed issue," which means all participating plans would be obligated to sell coverage to everyone, regardless of pre-existing medical conditions.
But this may all just be a front to shift the bulk of healthcare costs onto patients' shoulders. The San Francisco Chronicle notes: "On the surface, the Healthcare Choice Act sounds like consumer protection, but in reality it actually harms (consumers) by driving up prices."
The way the HealthCare Choice Act is worded now would apparently allow insurers far too much room for abuse: they could cherry-pick only the youngest and healthiest consumers, sell simple bare-bones policies that don't include preventive or acute care services, and would be exempt from state consumer-protection laws.
* Sigh * I knew it sounded too good to be true.
Shop Til You Drop
The debate rages on about how to reform healthcare in America… Meanwhile, what can we do to become more successful consumers?
If you ask me, I think one important action is changing our attitude about healthcare, to become more active and assertive. HSA and FSA accounts were supposed foster this, the idea being that with a financial stake in our own healthcare spending, we patients would have incentives to shop for the best price and make tradeoffs between convenience and cost.
I'm not sure that's happened yet. We're kind of conditioned to believe that healthcare is one area where we take a passive role, just accepting whatever we get. I know that despite spending HOURS filling out forms and photocopying receipts, my Flexible Spending Account hasn't yet changed my resolve to being "stuck with" a number of healthcare choices I don't like.
We all should be more assertive, and realize that a time has come when we can shop for healthcare products and services like we would for other items: do your homework, shop around, and speak up if you've had a poor customer experience.
We can also use the Internet and in particular the blogosphere to learn about our choices, and to share experiences and air problems if and when appropriate. We consumers may not be in the healthcare driver's seat yet, but we can at least become more vocal back-seat drivers!
Read more about Amy Tenderich.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
Tomato and Goat Cheese Salad Any-Vegetable Parmesan Microwave Delight Fruit Slushy Oatmeal & Apple Mini Muffins Dill Chicken Salad Spiced Lamb Chops Asian Inspired Stir Fry Mexican Ceviche BBQ Meatloaf Orange Smoothie
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...